Sport Club Participation Information

The University of Texas at Arlington - RELEASE AND INDEMNIFICATION AGREEMENT

Each person competing on a recognized UTA Sport Club or competing at a UTA hosted event must have a waiver on file in the Campus Recreation Office. Persons may still be claimed on parents insurance or they may choose to purchase the student insurance at a minimal cost. Medical insurance is highly recommended.

Sport Club (Choose One) *
Name Name * First Last
UTA ID #
UTA Email Address (non-UTA email address if needed) *
Phone Number Phone Number * - ### - ### ####
Expected Graduation Date: *
Current Academic Year: *
Parent's Name (if under 21) Parent's Name (if under 21) First Last
Allergies, Illnesses, or Special Needs *
Emergency Contact Emergency Contact * First Last
Emergency Contact Phone Number Emergency Contact Phone Number * - ### - ### ####
Emergency Contact Relationship *
I, the above named student, am eighteen years of age or older and have voluntarily applied to participate in the above Activity or Trip. *

I, the above named student, am eighteen years of age or older and have voluntarily applied to participate in the above Activity or Trip. I AGREE
I acknowledge that the nature of the Activity or Trip may expose me to hazards or risks that may result in my illness, personal injury or death and I understand and appreciate the nature of such hazards and risks. *

I acknowledge that the nature of the Activity or Trip may expose me to hazards or risks that may result in my illness, personal injury or death and I understand and appreciate the nature of such hazards and risks. I AGREE
I acknowledge that the nature of the Activity or Trip may expose me to hazards or risks that may result in my illness, personal injury or death and I understand and appreciate the nature of such hazards and risks. *

I acknowledge that the nature of the Activity or Trip may expose me to hazards or risks that may result in my illness, personal injury or death and I understand and appreciate the nature of such hazards and risks. I AGREE
In consideration of my participation in the Activity or Trip, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release the above named Institution, its governing board, officers, employees and representatives from any liability to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation in the Activity or Trip, whether caused by negligence of the Institution, its governing board, officers, employees, or representatives, or otherwise. *

In consideration of my participation in the Activity or Trip, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release the above named Institution, its governing board, officers, employees and representatives from any liability to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation in the Activity or Trip, whether caused by negligence of the Institution, its governing board, officers, employees, or representatives, or otherwise. I AGREE
I further agree to indemnify and hold harmless the Institution and its governing board, officers, employees, and representatives from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in the described Activity or Trip. *

I further agree to indemnify and hold harmless the Institution and its governing board, officers, employees, and representatives from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in the described Activity or Trip. I AGREE
I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY OR DEATH OR DAMAGE TO MY PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED ACTIVITY OR TRIP AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTIONAL ACT OR OMISSION. *

I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY OR DEATH OR DAMAGE TO MY PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED ACTIVITY OR TRIP AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTIONAL ACT OR OMISSION. I AGREE
By checking this box, I agree to all terms of this waiver. *

By checking this box, I agree to all terms of this waiver. I AGREE
By typing your name below, you are agreeing to all terms of this waiver. By typing your name below, you are agreeing to all terms of this waiver. * First Last
Today's Date Today's Date * / MM / DD YYYY